Ultrasonography is valuable for detecting
lymph-node metastases and local recurrence in patients with thyroid
carcinoma
(March 2004)
The background of the study.
Many patients with thyroid carcinoma have tumor in lymph nodes in
the neck. Later recurrence may be minimized by better detection
of nodal involvement and resection of the nodes. This study evaluated
the value of physical examination and ultrasonography for the detection
of local and regional spread of tumor in patients with thyroid carcinoma.
How the study was done.
The records of 212 patients with thyroid carcinoma who underwent
ultrasonography of the neck before surgery between 1991 and 2003
were reviewed. The patients were divided into three groups according
to whether their surgery was for initial therapy, persistent tumor
(defined as reoperation within six months after initial surgery),
or recurrent tumor (defined as reoperation more than six months
after initial surgery).
The results of the study.
Ultrasonography revealed lymph-node metastases or soft-tissue recurrence
in 113 of the 212 patients (53 percent). The lymph-node metastases
or local recurrence was not detected by physical examination in
34 percent of the patients with differentiated carcinoma and 49
percent of those with medullary carcinoma. Lymph nodes containing
tumor or tumor involving soft tissue were removed from 183 of the
212 patients (86 percent). Ultrasonography proved to be a very sensitive
test for detecting tumor in lymph nodes.
The conclusions of the study.
In patients with thyroid carcinoma, ultrasonography of the neck
often reveals tumor in lymph nodes and soft tissue of the neck that
cannot be detected by physical examination, and therefore leads
to more extensive tumor removal.
The original article.
Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman
SI, Vassilopoulou-Sellin R, Lee JE, Evans DB. Role of preoperative
ultrasonography in the surgical management of patients with thyroid
cancer. Surgery 2003;134:946-55.
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